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Web Accessibility Content Review Guides Guides to Review for Digital Accessibility Emily Lapayowker These actionable guides help you prepare accessible web and digital content. Digital accessibility is an important process that makes websites, files like Word documents or PDFs, and other digital products accessible to people with disabilities, as well as making these products more user-friendly overall. There are many criteria to meet when making your digital content accessible. The guides on this page serve as checklists for ensuring that web content and digital products are accessible, as laid out in the 2024 ADA Title II Web Rule, and meet the current standard of WCAG 2.1. Neither will address the web development needs laid out in WCAG, but they are useful for most digital content creation. The two checklists represent two different approaches to meeting accessibility standards: standards-driven and content-driven. It is important to remember that many of the techniques contained in each are not exclusive to websites, emails, or Microsoft Office products; they can be used for all forms of digital content. Guide for Meeting WCAG Web Accessibility Standards The structure of this checklist template roughly corresponds with the Preliminary Easy Checks Checklist by W3C. Each section contains a list of relevant WCAG links that detail the criteria and conformance levels covered in that section. It also indicates which checks are manual and which can be done by an automated checker, like the applet ANDI. Get the Checklist for Meeting WCAG Accessibility Standards (automatic Word download) Special Thanks - Resource - Guide for Meeting WCAG Web Accessibility Standards Padding Block - Large Padding Block - Small Guide to Reviewing Digital Content for Accessibility This checklist has a content-first focus and is less technical than the Guide for Meeting WCAG Web Accessibility Standards. Sections are organized to keep like-topics together. Overarching sections include document content, document structure, and multimedia. Get the Guide to Reviewing Digital Content for Accessibility (automatic Word download) Padding Block - Medium OE22-2203 PHIG article yes

Learn about engaging partners in a virtual space, with actionable steps, examples, and resources.

For many individuals living with disabilities, inaccessible vaccination websites have been a significant barrier to receiving the COVID-19 vaccine. Recent studies have found that many vaccination websites do not reliably meet accessibility standards. This brief discusses how several disability rights laws apply to COVID-19 vaccine registration websites and offers considerations for state and territorial health agencies as they work to improve website accessibility for people living with disabilities.

Basic PDF Accessibility Remediation Demonstration How to Remediate a PDF for Accessibility This video is a demonstration of basic PDF remediation techniques using Adobe Acrobat Pro. The methods in the video address some of the most common fixes needed to make a PDF converted from Microsoft Word accessible. This includes: How to access document properties, and which fields you should fill out. How to run the accessibility checker and why it is always necessary to check the checker’s results. The difference between tag structure and logical reading order. How to create new sections in a PDF. How to move and change tags. Speaker Emily Lapayowker, Assistant Director, Web Content, ASTHO Transcript - Video - Basic PDF Remediation Demonstration   Adobe Remediation Cheat Sheet This section serves as a quick reference for the skills included in the demonstration. Note that both the demonstration and this resource use a mouse to navigate Adobe Acrobat Pro. The processes will be different for those using keyboard navigation. Document Properties Menu Document Properties (toward the bottom of the Menu) Description Tab: Title Author (optional) Subject & Keywords – These fields make it easier for screen reader users to search for and identify your document. Advanced Tab: Language (in the Reading Options section) - Make sure the language selected matches the language in which your document is written. This is how screen readers know what language to use. Save changes by selecting the OK button on the Document Properties dialog box. Accessibility Checker The Adobe Acrobat Pro version used in this demonstration is 2026.001.21529. Other versions may have a different layout, but the functionality for all recent versions should be roughly the same. Click on All Tools in the header menu. From the All Tools menu pane, choose “Prepare for Accessibility.” Note that it may be necessary to select “View More” on the menu pane if Prepare for Accessibility is not immediately visible. In the Prepare for Accessibility menu, choose “Check for Accessibility.” A dialog box of Accessibility Checker Options will open. Set the desired parameters and click the “Start Checking” button. An Accessibility Checker pane will appear on the opposite side of the window. It will catalog all of the accessibility issues it detects. Open each item to get more information. Some items must be manually approved. These include Logical Reading Order and Color Contrast. The checker cannot check these for you. To manually pass something, right-click on the item and choose “Pass” from the context menu (i.e., the right-click menu). It is vital to check the checker. All checkers start with the assumption that the document or page in question has been created already using best practices and cannot check some elements as thoroughly as a human can. They are a great starting place, but should not be considered the final word. Tags Tags are the structure of a PDF. They should be the first stop when remediating a document. To open the tags, check the far side of the Accessibility Checker pane. There will be a button with an icon shaped like a gift tag. Click on the icon and the Accessibility Tags will replace the checker results in the pane. All tags should be listed under a top-level Tags item with the PDF icon next to it. Under that will be a Document tag — in almost every instance, the rest of a PDF’s tags will live under the Document tag as well. Tips Clicking on a tag in the structure will highlight the corresponding section in the document. The relevant area will be enclosed in a purple box. Make sure the document structure is correct. This means: Headings are used in order, none are skipped. In almost every case, there will be only one H1 per PDF. H2s should be used as section headings, H3s as subsections, and so on, down to H6. Empty tags can and should be deleted. Right-click on an empty tag and select Delete Tag from the context menu. The context menu has an option to Delete Empty Tags. This is faster, but it is important to check the results. Creating New Tags in the Tags Pane All page content should have a corresponding tag. If a tag is missing, create a new one. Click on a tag near where the new one should go. Click the three dots in the upper right corner of the Tags pane. Select “New Tag” from the context menu. Set the correct tag type by using the dropdown field. In the demonstration video, it is Section. The empty Sect tag will appear in the Tags pane. If it is not in the right place, click on the tag and drag it to the correct location. Add content to the new tag by clicking on the relevant content and dragging it into the new tag. If this is done correctly, the content will appear under and slightly to the right of the new tag (much like a subitem in a list). Nested Tags: Lists Lists are an example of when to use nested tags. The top-level tag in a list should be List, which shows up in the tag order as an L. Under that, each list item should be labeled LI. Within each LI should be two sub-tags: Lbl (or label — a bullet or a number) and LBody, which will contain the text for that list item. Create new tags, change tag type, and/or drag-and-drop content to correct any tagging errors. Nested Tags: Tables Tables are another common type of nested tag. When evaluating tables: Make sure everything is nested under a Table tag. The top row of content should always be nested under a heading tag (THead). Though the sub-tag for the row will be a normal TR, the individual header cells in the row should be tagged as TH. The rest of the table content should be nested under a TBody tag. These will be split up by row (TR). Individual cells should be tagged as TD. Note that if the first column should also be treated as a heading, the tags will still be nested under TBody and inside a TR tag, but the first cell in the row will be a TH. Only use tables for data, not for styling. Try to avoid empty and merged cells. Screen readers go through tables top-to-bottom, left-to-right, one cell at a time. Changing Tag Types Incorrectly categorized tags can be changed (e.g., the title is tagged as a regular paragraph when it should be an H1). Right-click on the existing tag and choose Properties from the context menu to open the Object Properties dialog box. Use the dropdown menu in the Type field to select the correct tag type. Note that tag types are listed alphabetically. Select the “Close” button to save the changes. Reading Order Reading order should be adjusted after the Tags. Typically, it will mirror what you see in the Tag pane, but not always. As the name implies, it is the order in which a screen reader will read the document. To access the Reading Order pane, look at the far end of the Tags pane and there should be an icon that looks a bit like a Z — that is the Reading Order button. Click on it and Reading Order will replace the Tags. The Reading Order content is divided up by page, which makes it easier to stay on track. Removing Items from the Reading Order In the demonstration example, there are three decorative lines inserted in the content to help visually break up the content. Each is marked as a Figure and each generated a flag from the accessibility checker because there was no associated alt text. No alt text is needed for these lines because they are decorative (meaning they do not give the reader any additional information). The best way to remove them from the reading order is to mark them as “background/artifact.” Right-click the decorative item in the Reading Order pane. Choose “tag as background/artifact” from the context menu. The item will disappear from the reading order, but the decorative line will remain visible on the page. Note that sometimes this does not work and you end up with empty or erroneous items in the reading order. Known Conversion Errors It is possible to create a completely accessible document in Microsoft Word and still have errors when it is converted to a PDF. Some of these problem areas may be the result of known conversion errors, such as: Images (or figures) moving to the bottom of the reading order, regardless of where they are placed on the page. Empty P tags where the author has used the Enter/Return key to move to a new line. Unfortunately, these are not preventable issues. Any fixes have to be done by Adobe, so it is important to watch out for them when remediating a document. article yes

Advanced Accessibility Training Advanced Digital Accessibility Training Take a deeper dive into digital accessibility with members of ASTHO's Graphic Design and Web teams. This session will build on skills from the October 2025 training by covering the legal requirements and landscape, basic document remediation strategies, and the overlap between web and document accessibility. After this session, attendees should be able to: Understand the ADA Title II Web Rule requirements. How to communicate the importance of embracing accessibility. Be familiar with common document remediation strategies. Understand the commonalities between website and document accessibility. Speakers Emily Lapayowker, Assistant Director, Web Content, ASTHO Christopher Preheim, Manager, Graphic Design, ASTHO Heidi Satter, Director, Web & Data Solutions, ASTHO Resources Slide Deck (PDF) Fact Sheet: New Rule on the Accessibility of Web Content and Mobile Apps Provided by State and Local Governments Transcript - Video - Advanced Accessibility Training article yes

Accessibility Pillars in Web and Design Learn the core principles of accessible web and document design in public health, aligned with ADA guidelines, to ensure resources are usable by all communities. Accessibility in web and document design ensures that digital content is usable by everyone. This presentation introduces the core principles of accessibility, aligned with Americans with Disabilities Act (ADA) guidelines, and empowers you to recognize and implement accessible design practices. By the end of this webinar, participants will be able to: Identify visual elements in a document as accessible or inaccessible without external guidance. Understand the importance of inclusive design and its impact on users with disabilities. Apply accessibility principles to everyday digital products and workflows. Recognize the legal and ethical standards required for compliance. Resource Slide Deck (PDF) Speakers Emily Lapayowker, Assistant Director, Web Content, ASTHO Christopher Preheim, Manager, Graphic Design, ASTHO Heidi Satter, Director, Web & Data Solutions, ASTHO Transcript - Video - Accessibility Pillars in Web and Design OE22-2203 PHIG article yes

Understanding Digital Accessibility Before the ADA Title II Deadline Emily Lapayowker, Adrianna Evans With the ADA Title II deadline looming, learn how to prioritize and improve digital accessibility on your agency’s website. Digital accessibility ensures the digital world is usable for everyone. And while it is an increasingly prominent topic in public health, there is still much to learn. This resource can help public health agencies understand digital accessibility basics and promote accessible communications for the disability community, which is typically underserved in public messaging. Government Laws and Requirements ADA The Americans with Disabilities Act is a federal civil rights law that prohibits discrimination against and requires equitable access for people with disabilities. ADA’s connection to digital accessibility may not be immediately apparent, but digital accessibility is covered under the large umbrella of equal access to public areas that ADA guarantees. In fact, Title II of ADA enforces digital accessibility compliance by requiring state and local government websites and digital tools be accessible to people with disabilities — the Department of Justice has announced a compliance deadline of April 24, 2026, for jurisdictions of 50,000+ people and April 26, 2027, for smaller entities. Sections 504 and 508 Section 504 of the 1973 (Vocational) Rehabilitation Act requires any entity that gets federal funding to provide equal access to electronic information technologies for people with disabilities. Section 508 requires the federal government to meet those same standards. These sections were initially written in 1998 and then updated in 2018 to include requirements for mobile technology. WCAG Is the Industry Standard The Web Content Accessibility Guidelines, or WCAG, is published by the World Wide Web Consortium (W3C), an international organization that establishes open web standards. WCAG is currently in its second version. When evaluating compliance, there are three different WCAG conformance levels: A (lowest), AA (middle), and AAA (greatest). Interestingly, W3C recommends that all web-based information aim to hit AA because it is not possible for some types of content to reach AAA compliance. WCAG 3.0 is currently in development and expected to be a major paradigm shift. POUR Principles WCAG standards are principle-based, which means that rather than requiring all web browsers to meet a specific technical standard, WCAG requires that digital content adheres to the POUR principles. All four principles focus on the user’s experience: Perceivable: All information must be presented in a way that ensures users can perceive it using at least one of their senses. Operable: A website is considered operable if all users can effectively navigate it, even those who employ assistive technology, such as screen readers. Understandable: This is a two-pronged principle — users must be able to understand how to use a site and understand its content. Robust: Content must be robust enough that multiple technologies, including assistive devices like screen readers, can interpret it. These laws and guidelines are minimally prescriptive to promote longevity. Remaining principle-based rather than tech-based means these standards will not become obsolete as technology advances. Where and How to Make the Biggest Impact Health agencies can make small changes to digital content in a few key places that will make a world of difference for users with visual, hearing, physical, and cognitive disabilities. Some examples include emails, PDFs, website and social media content, and staff resources. Link Smart and Sparingly Screen reader technology allows low-vision users to navigate webpages and other digital content in a variety of ways. One is by jumping from link to link without referencing the content around that link. So, make your linked text descriptive enough to stand on its own. Also, avoid typing out URLs whenever you can — screen readers will read aloud the URL as phonetically as possible, which is not a great user experience. Additionally, when a screen reader reaches a link in the content, the software will announce it. Use links sparingly to avoid major disruption to the reading experience, as over-linking can make it hard to keep track of the content. Use the Built-In Text Styles Document hierarchy is another essential part of accessibility remediation. The built-in font styles, such as headers and lists, are for more than just aesthetic — screen readers use these styles to navigate Word documents, PDFs, and webpages. Use headers in order (i.e., never skip a heading level), and deploy ordered and unordered lists thoughtfully. For example, if you list specific steps in a process, use an ordered list. If you list symptoms of a viral infection, an unordered list is a better fit. Use Color and Contrast Correctly Do not rely on color alone to convey important information, because users with low vision or colorblindness may have trouble differentiating between different colors or shades. Best practice is to use additional visual markers to signal the presence of important information and ensure there is at least a 3:1 contrast ratio for graphics. Follow Alt Text Best Practices Screen readers read alternative text (or alt text) to allow users with visual or specific cognitive disabilities to understand the content and purpose of an image, table, or informational graphic. Some alt text best practices: Be succinct. The ideal length is between a few words and a couple of short sentences (use the average length of a post on X as a guide, about 250 characters). The goal is to be brief but still convey the image’s vital information. Avoid phrases like “image of” because screen readers will identify all images as such, which makes this redundant. The context around the image is just as crucial as the alt text. If there is already a detailed description of a virion’s shape in the document's body, repeating all that information in the alt text is unnecessary. Not all images convey information. In those cases, it’s important to use null alt text, which will let assistive technology know that the image is decorative. To do this, either add “decorative” in the alt text field, or mark it as decorative in the platform, if that option is available. When creating complex images such as charts or graphs, communicate what the graph is telling users rather than just what it looks like. Learn More There is a whole world to learn about within digital accessibility, but there are resources and experts to help. You can connect with internal experts on your IT team or external disability and accessibility organizations for support. You can also learn more about digital accessibility at the following resources: Introduction to the Americans with Disabilities Act by U.S. Department of Justice. Civil Rights Division Section 508 (Federal Electronic and Information Technology) by U.S. Access Board What Is Plain Language? by Plain Language Action and Information Network Constructing a POUR Website by WebAIM WCAG 101: Understanding the Web Content Accessibility Guidelines by Level Access Glossary of Disability-Related Terms by University of Washington Accessibility Online by Great Lakes ADA Center Related Content-Blog - DELPH Magazine 4 article yes